No. 78
December 1993
HOSPnAUZAnON AMONG ELDERLY
NORTH CAROUNA RESIDENTS
nSCAL YEAR 1990
by
M.D. Nelson, Jr.
INTRODUCTION
N C. DOCUMENTS
CLEARINGHOUSE
FEB t 1994
N.C. STATE LIBRARY
RALEIGH
As North Carolina's elderly population has grown, and as health care expenditures have
increased, understanding the health problems and health care needs of our older citizens has
become increasingly important From 1971 to 1991 the population of North Carolinians aged 65
years and older increased 88 percent A 1989 SCPiES Study examined mortality among persons
aged 65 and older as it relates to the health of that population.' Hospital discharge data for persons
aged 65 and older are presented here as another indicator of the health problems and health care
needs of older North Carolinians.^ While constituting only 12 percent of North Carolina's total
population, persons aged 65 and older accounted for 27 percent of inpatient hospital discharges^
38 percent of hospital bed days*, and 40 percent of hospital charges (fiscal year 1990). Excluding
newborns from the data allows comparisons to national figures^. Older persons accounted for 31
percent of hospital discharges (US 34%), 43 percent of hospital bed days (US 45%), and 42 percent
of hospital charges (US data not available).
This report examines inpatient hospital usage among elderly persons in North Carolina
during fiscal year 1990 based on age group, principal diagnosis, and county of residence. Hospital
usage and resource consumption were measured by 1) number of discharges, 2) discharge rate, 3)
hospital length of stay, and 4) charges per hospital visit This report focuses on North Carolina
residents ages 65 and older. Tables and maps detailing age groups and county of
residence can be found in the Appendices.
^fA^ NORTH CAROLINA DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DEHrslF=<
DATA AND SOURCES
The data c»nsist of inpatient hospital dis-
charge reconds for North Carolinians ages 65 and
older for October 1989 through September 1990,
obtained from the North Carolina Medical Data-
base Commission. The primary source docu-
ment for information in the Commission's data-
base is the UB-82 claim form used by hospitals to
bill payers. This form includes patient's county
and state of residence, patient's age and sex, payer
identification, principal and other diagnoses,
length of stay, and total hospital charges per stay.
The UB-82 does not collect data on patient's race,
patient's income, or causes of injuries.
Population bases were obtained from the
State Data Center, Office of State Planning. Dis-
charge rates are presented per 1,000 population
ages 65 and over.
Diagnoses are grouped into 33 discrete con-
ditions listed in the International Classifiaition of
Diseases, 9th Revision, Clinical Modification (ICD-9-
CM). The groupings were narrowed to focus on
recogiuzed conditions of public health impor-
tance, for many of which risk factors or potential
interventions are known. Some analyses focus on
only the principal* diagnosis, and others on any
of the five possible diagnoses listed.
Payers were divided into five classes: Med-
icaid, Medicare, Private or Employer Provided,
Self Pay/Indigent/Charity,and Other. Privateor
Employer Provided consists of Blue Cross and
Blue Shield, CHAMPUS, State Employee Healti\
Plan, any health maintenance organization, com-
mercial insurance, administered plans, and Work-
men's Compensation. Self Pay/Indigent/Char-
ity also includes payments by the North Carolina
EXvision of Health Services Purchase of Care
Program.
SELECTED RESULTS
In fiscal year 1990, 228,252 hospitalizations
occurred among the elderly. Nineteen major
categories of conditions accounted for 51.2 per-
cent of all discharges. Table 1 gives discharge
rates, average hospital lengths of stay, and aver-
age hospital charges per stay for three age groups.
The discharge rate rose with age from 230.2 per
1 ,000 at age 65 to 74 to 446.9 per 1,000 at age 85 and
older. Average hospital length of stay rose from
10.7 days for 65-74-year-olds to 12.1 days for 75-
84-year-olds; the average hospital length of stay
for ages 85 and older was also 12.1 days. Average
hospital charges per stay decreased with age from
$8,770 for 65-74-year-olds to $7^54 for persons
aged 85 and older.
TABLE 1
INPATIENT HOSPITAL UTILIZATION
NORTH CAROLINA RESIDENTS BY AGE GROUP
OCTOBER 1989 — SEPTEMBER 1990
Average
Number of Discharge Average Charges
Discharg es Rate Days Stay per Stay
Ages 65-74 111,167
Ages 75-84 85,150
Ages 85 and older 31,935
Ages 65 and older 228,252
230.2
338.6
446.9
283.3
10.7
12.1
12.1
11.4
$8,770.45
$8,587.94
$7,853.74
$8,574.11
The principal diagnosis is that deenned, at discharge, to have been responsible for the patient's admission to the hospital.
2
Principal Diagnosis
Hospital use measures are presented for
selected principal diagnoses in Table 2. The
categories shown accounted for more than half of
the discharges (51%), days of care (59%), and
hospital charges (54%). Heart disease was the
most frequent reason for hospitalization among
persons aged 65 and older (61.0 hospitalizations
p)er 1,000 persons). These patients had an average
length of stay of 8.1 days and used 15 percent of
the total days of care. Heart disease accounted for
23 percent of hospital charges incurred by per-
sons aged 65 and older. The heart disease dis-
charge rate was 30 percent higher for males than
for females. While females had a slightly higher
average length of stay, the average cost f)er hospi-
talization for heart disease was 22 percent higher
for males.
Cancer was the second leading principal
diagnosis with 21.0 hospitalizations per 1,(X)0
persons, which was 7.4 percent of total discharg-
es. The average length of stay for persons dis-
charged with cancer was 10.9 days; they used 7.1
jjercent of the total days of care. These hospital-
izations accounted for 8.7 percent of elderly hos-
pital charges. The male discharge rate for cancer
was 70 percent higher than that for females, and
while females tended to have longer hospital
stays, they incurred lower hospital charges. The
most frequent elderly hospitalizations for cancer
were lung, breast and prostate.
Cerebrovascular disease and pneumonia/
influenza were the third and fourth most frequent
diagnoses with rates of 17.5 and 16.2 hospitaliza-
tions per 1,000 persons, respectively. For these
conditions, males had higher discharge rates,
shorter lengths of stay, and higher hospital charg-
es than females.
Patients with a principal diagnosis of mental
disorders had a particularly long average length
of stay (63.6 days). They used 17.5 percent of total
days of care and incurred 3.2 percent of total
hospital charges. While discharge rates and the
average hospital charges per stay were very sim-
ilar for males and females, the average hospital
stay for males was 62 percent longer than that for
females.
Tables detailing hospital resource consumpv
tion by principal diagnosis for the age groupjs 65-
74, 75-84, and 85 and older can be found in the
Appendices.
Comorbid Conditions
Comorbid conditions are recorded diagnoses
that coexist at time of admission, or develop
subsequently, and affect the length of stay and/
or the treatment received. The ratios of the
number of discharge records that had any men-
tion of a given condition to the number that had
that same condition listed as the principal diagno-
sis are presented in Table 3. A low value indicates
that the condition was usually the principal cause
of the hospitalization. A high value indicates that
the condition usually relates to hospitalization as
a contributing condition rather than as the main
cause. For hospitalizations to all persons ages 65
and older, the five highest ratios were for hyper-
tension (48.1), nutritional disorders (26.6), thy-
roid gland disorders (22.6), Alzheimer's disease
(17.2), and glaucoma (12.7). When taken by age
group, these five conditions continued to consti-
tute the highest ratios.
Payer Class
Medicare was the principal payer for 95
percent of hospitalizations to residents ages 65
and older (Table 4). Length of hospitalization and
average hospital charges varied according to
principal payer. The average days stay for Med-
icaid patients was 133.9, much higher than that of
the otiier payer classes: Selfpay /Indigent/Char-
ity (84.2), Medicare (10.1), and Private or Employ-
er provided (9.3). The average hospital charges
were $12,421 for Medicaid, $8,957 for Private or
Employer pro vided,$8,942forSelfpay/Indigent/
Charity, and $8,504 for Medicare.
DISCUSSION
Although persons ages 65 and older com-
prise only 12 fjercent of the population in North
Carolina, they account for 40 percent of hospital
costs. These figures are comparable to national
statistics* and the findings in other states^. The
Census Bureau estimates that the elderly popula-
tion will increase to approximately 22 percent of
the population by the year 2030.*' As the popu-
lation ages, an even grea ter f)ercentage of hospi tal
costs will be attributed to the elderly.
In tlie 1989 SCHESStudy of mortality among
persons aged 65 and older^ the leading causes of
death were heart disease, cancer, cerebrovascular
disease, pneumonia /influenza, and chronic ob-
structive pulmonary disease. These diseases are
also the leading causes of hospitalization in this
age group.
The number of hospital discharges, the rate
of discharges, the average days of stay, and the
average hospital charges all reasonably indicate
the burden of hospitalization attributable to each
principal diagnosis. However, the contribution
of comorbid conditions to hospitalization is prob-
ably underestimated by the number of discharg-
es and the ratio of all-listed diagnoses to principal
diagnoses. The hospital discharge records can
accommodate only five diagnostic codes, and all
five are used in 65 percent of the hospital dis-
charge records for persons 65 years of age and
older. Many of the original hospital records may
have contained more than five diagnoses; the
omission of diagnoses beyond the fifth would
result in a downward bias in the ratio of the all-
listed to principal diagnoses.
While the hospital discharge rates by county
of residence or by principal diagnosis serve as
indicators of the level of hospitalization, they
should not be taken to represent the incidence of
hospitalization in the population. In these hospi-
tal discharge data, one cannot distinguish
between persons having only one hospitalization
and persons having more than one hospitaliza-
tion. Personal identifiers are not part of the
hospital discharge file. Hospitalizations could
not be examined by person-sp>ecific data. Other
research has shown that within a single year, as
many as 1 1 .8 percent of pa tients are readmitted.^"
The average days stay and hospital charges
for Medicaid patients were found to be much
higher than that for any other payer class. Ex-
tremely ill patients who exhaust their Medicare
benefits may resort to Medicaid benefits. Also,
Medicaid would cover p>ersons who are not eligi-
ble for Medicare. These Medicare ineligibles may
have been disabled for a lifetime, never em-
ployed, and therefore never have contributed to
the Sodal Security System.
Additional studies could shed light on three
seemingly anomalous findings: 1) for heart
disease and cancer, the two leading principal
diagnoses, females experienced, on the average,
longer hospital stays than males but incurred
lower hospital costs; 2) the average hospital
charges went down with increasing age, although
the average days stay was longer; and 3) for
Medicaid patients, the average hospital stay is 10
times longer and nearly 50 percent more costly
than that of Medicare patients. Further, it is hoped
that these data on hospitalization of the elderly in
North Carolina will prove useful to those in-
volved in the prevention and treatment of health
problems in this population.
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TABLE 3
RATIO OF MENTIONED TO PRINQPAL DIAGNOSES
INPATIENT HOSPITAL DISCHARGES
OLDER NORTH CAROUNA RESIDENTS BY AGE GROUP
OCTOBER 1989 — SEPTEMBER 1990
Ages 65
Ages
Ages
Ages 85
Piagnosis
and over
65-74
75-54
and over
Infectious and parasitic disease
3.4
3.6
3.3
3.2
Oincer
1.8
1.8
1.7
1.9
Lung
Z4
2.5
12
15
Skin
1^
1.7
1.8
11
Female breast
13
1.2
1.3
1.6
Cervix uteri
1.7
1.7
1.7
1.5
Ovary & other uterine adnexa
14
Z4
2.4
1.9
Prostate
1.7
1.6
1.9
2.3
Bladder
1.4
1.5
1.4
1.4
Brain
1.4
1.4
1.4
15
Thyroid
15
1.3
1.6
18
Hodgkin's disease
3.0
2.7
4.5
3.0
Leukemia
4.2
3.8
4.4
5.1
Thyroid gland disorders
22.6
18.0
28.2
33.6
Diabetes
11.1
10.5
110
111
Nutritional disorders
26.6
32.6
24.9
23.3
Mental disorders
3.7
3.0
3.9
6.4
Psychoses
2.8
2.0
3.1
5.4
Alcohol dependence syndrome 3.8
35
5.1
4.3
Drug dependence
9.7
7.5
176
»
Alzheimer's
172
116
15.1
36.9
Parkinson's
11.4
8.9
118
15.2
Glaucoma
12.7
9.0
13.6
65.3
Cataract
4.3
4.6
4.3
3.9
Heart disease
7.3
11
2.4
19
Hypertension
48.1
45.3
51.3
54.9
Cerebrovascular disease
1.7
1.7
1.7
1.7
Pneumonia and influenza
1.6
1.6
1.6
1.5
COPD
9.9
8.9
10.8
14.0
Panaeatitis
1.9
1.8
10
1.9
Nephritis, nephrotic
syndrome, and nephrosis
7.4
76
7.4
71
Rheumatoid arthritis
5.6
4.6
8.1
117
Poisoning
1.6
1.5
1.6
1.9
*No principal diagnosis in this category.
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REFERENCES
1. State Center for Health Statistics. Health of the Elderly in North Carolina: Population at Risk and
Patterns and Trends in Mortality. SCHES Studies, No. 51, June 1989, North Carolina Division of
Health Services.
Z State Center for Health Statistics. The use of hospital discharge data for estimating morbidity in
North Carolina. SCHES Studies, No. 20, July 1981, North Carolina Division of Health Services.
3. North Carolina Medical Database Commission. Hospital patient origin report — October 1 , 1989
through September 30, 1990. H91025. North Carolina Department of Insurance.
4. North Carolina Medical Database Commission. Hospital patient origin report — October 1, 1989
through September 30, 1990. H91025. North Carolina Department of Insurance.
5. Graves EJ. National hospital discharge survey: annual summary, 1990. National Center for Health
Statistics. Vital Health Stat 13(112), 1992.
6. Rosenthal GE. Do older Medicare patients cost hospitals more? Archives of Internal Medicine.
1993;153(l):89-%.
7. Executive summary: factors driving health care in Kansas. Kansas Medicine. 1992Dec,-93(12):327-
46.
8. US Bureau of the Census. Projections of the population of the United States, by age, sex, and race:
1988 to 2080. Current Population Reports. January 1989; Series P-25.
9. Rice DP, Feldman JJ. Living longer in the United States: demographic changes and health needs
of the elderly. Health Society. 1983; 61:364.
10. Acheson ED, Barr A. Multiple spells of in-patient treatment in a calendar year. British Journal of
Preventative and Sodal Medicine. 1965, 19:182.
APPENDIX A.1
[NPATIENT HOSPITAL UTILIZATION DATA BY COUNTY
NORTH CAROLINA RESIDENTS AGES 65 AND OLDER
OCTOBER 1989 — SEPTEMBER 1990
Number of
Discharge
Average
Average
Counties
Discharges
Rate
Days Stay
Charges
State
228,252
2833
11.4
$ 8374.11
Alamance
3,742
230.7
10.1
9,684.77
Alexander
1,108
370.6
8.5
8,635.58
Alleghany
686
393.1
6.6
4307.95
Anson
877
235.6
9.5
9,288.50
Ashe
1.224
322.2
7.4
5,632.54
Avery
1,015
477.4
6.9
5363.61
Beaufort
1,962
314.1
9.2
6,936.01
Bertie
926
307.2
10.7
7,448.50
Bladen
1,196
294.7
8.4
7,638.36
Brunswack
2,101
286.9
8.4
7,251.63
Buncombe
6,774
241.6
10.5
8,779.58
Burke
3,040
3113
13.6
8,112.82
Cabarrus
4,605
349.0
11.9
8377.22
Caldwell
2,705
317.4
9.1
8,840.42
Camden
138
166.5
9.8
7,976.84
Carteret
2,211
296.6
9.2
8,045.46
Caswell
287
98.1
110
10,100.73
Catawba
3,291
231.4
10.9
10,773.46
Chatham
1373
249.4
10.0
8,179.75
Cherokee
1,177
309.2
6.5
6,073.99
Chowan
544
229.5
12.8
7367.63
Clay
275
191.4
5.5
5,435.22
Qeveland
3,288
284.2
13.7
8,425.43
Columbus
2,322
345.4
10.7
8,759.05
Craven
2,914
328.7
11.1
8,177.49
Cumberland
3,989
237.0
11.8
11,677.26
Currituck
230
133.8
14.6
7,985.43
Dare
357
120.0
16.3
8,888.96
Davidson
4,159
273.3
11.1
7312.25
Davie
1,477
401.6
8.7
6,484.02
Duplin
1,707
301.7
11.6
8,603.66
Ehirham
4,709
237.9
14.2
10,621.41
Edgecombe
2363
336.6
13.6
10,663.86
Forsyth
9,156
278.5
11.6
8396.73
Franiklin
1317
303.3
9.7
9,047.11
Gaston
5,682
267.7
12.1
8,743.94
Gates
183
129.3
9.0
6,848.00
Graham
291
255.7
7.5
6,160.81
Granville
1,181
241.4
9.8
8,703.02
Greene
514
269.1
11.7
8,701.93
Guilford
11,650
279.9
10.4
8,774.89
Halifax
2,703
334.4
20.7
9,068.55
Harnett
2349
324.8
10.4
8,138.63
Haywood
2,912
344.7
153
6,207.27
Henderson
4,420
295.3
10.1
6357.51
Hertford
1,012
300.8
10.1
7,142.45
Hoke
438
203.7
123
9,902.68
Hyde
303
338.2
6.6
5,918.39
IredeU
4,260
344.9
9.7
9,196.94
Jackson
1,238
342.9
7.0
5,752.15
APPENDIX A.1 (con't)
INPATIENT HOSPITAL UTILIZATION DATA BY COUN i Y
NORTH CAROLINA RESIDENTS AGES 65 AND OLDER
OCTOBER 1989 — SEKl EMBER 1990
Number of
Discharge
Average
Average
Counties
Discharges
Rate
Days Stay
Charges
Johnston
3^98
319.0
10.6
$ 9,024.37
Jones
497
3618
20.0
8,198.07
Lee
1^61
291.6
8.6
9,741.30
Lenoir
3,042
385.3
13.0
9358.55
Lincoln
1,497
258.1
16.6
9307.78
McDowell
1,652
323.4
8.1
7,174.26
Macon
1,774
340.4
6.8
5389.29
Madison
587
211.9
15.1
8,736.02
Martin
858
235.3
11.5
8372.03
Mecklenburg
11,171
229.5
11.3
10304.09
Mitchell
906
359.7
in
5,689.29
Montgomery
1,020
312.8
9.1
7302.03
Moore
3,063
256.8
10.6
8,035.98
Nash
2,911
308.1
11.3
11,278.53
New Hanover
4,272
287.1
11.2
8,907.91
Northampton
974
283.0
18.8
7,944.53
Onslow
2,018
296.5
11.4
7343.41
Orange
1,725
210.8
9.6
9,696.79
Pamlico
502
268.7
9.8
8,817.97
Pasquotank
1,053
241.6
12.9
8,738.55
Pender
1,120
274.4
9.0
7,798.48
Perquimans
387
199.4
8.4
6,930.24
Person
1,071
248.5
9.5
8,808.99
Pitt
2,986
281.9
12.7
9,726.61
Polk
862
242.1
7.2
5,463.64
Randolph
3,142
243.9
9.6
8,216.86
Richmond
2,245
352.7
9.0
8358.64
Robeson
3345
292.9
10.9
10,229.22
Rockingham
4,055
332.5
11.0
8,054.06
Rowan
3,950
231.5
10.1
6,984.90
Rutherford
2,206
248.0
9.5
7395.38
Sampson
Scotland
2,017
294.2
10.4
8346.82
1,142
304.5
9.2
8,966.79
Stanly
2,237
292.3
9.4
6,996.01
Stokes
1,218
290.5
10.5
7331.37
Surry
3,368
367.7
8.3
6,801.62
Swain
718
408.2
8.5
5,474.85
Transylvania
Tyrrell
LJnion
1,153
247.4
8.3
7316.98
161
237.1
in
7,209.04
1,962
238.0
11.3
9,623.93
Vance
U24
255.9
10.8
7378.12
Wake
10,435
311.0
19.6
9327.56
Warren
592
196.0
13.1
9,057.19
Washington
605
318.6
7.7
7,208.29
Watauga
1,207
309.4
8.6
6,603.21
Wayne
3,216
299.6
14.8
8,413.39
Wilkes
2,609
335.8
9.6
7,745.43
Wilson
2,507
300.1
12.7
9381.09
Yadkin
1,553
345.2
8.0
6,600.96
Yancey
820
313.9
8.7
7370.37
10
APPENDIX A.2
INPATIENT HOSPITAL UTILIZATION DATA BY COUNTY
NORTH CAROLINA RESIDENTS AGES 65 TO 74
OCTOBER 1989 — SEPl EMBER 1990
Number of
Discharge
Average
Average
Counties
Discharges
Rate
Davs Stav
Charges
State
111,167
230.2
10.7
$ 8,770.45
Alamance
1,981
203.1
9.5
10,375.19
Alexander
567
318.2
7.2
8,??8.75
Alleghany
280
286.0
6.5
4349.00
Anson
403
188.1
9.0
9,869.22
Ashe
486
232.8
6.9
6,303.80
Avery
444
354.1
7.6
6,297.62
Beaufort
986
270.4
8.9
7,296.74
Bertie
443
247.2
9.4
7,782.50
Bladen
629
256.0
7.4
7,479.73
Brunswick
1,056
210.2
7.8
7,657.07
Buncombe
2,929
184.1
9.9
8,507.42
Burke
1,402
238.4
10.9
8,013.54
Cabarrus
2,165
278.2
9.7
8309.87
CaldweU
1,292
251.2
8.7
8,868.85
Camden
73
142.3
9.3
7,760.54
Carteret
1,198
251.5
8.5
8346.37
Caswell
128
72.6
10.8
9,406.14
Catawba
1,665
191.7
9.4
11,158.35
Chatham
643
195.4
9.0
8,296.28
Cherokee
504
225.7
6.0
6,064.03
Chowan
226
163.9
8.0
7,936.04
Clay
107
122.7
5.0
5,413.82
Qeveland
1,571
229.3
14.6
8,620.85
Columbus
1,151
281.3
9.4
8,401.47
Qaven
1,532
268.9
9.2
8,216.70
Cumberland
2,128
191.8
10.8
11,909.82
Currituck
103
95.9
20.4
7,819.25
Dare
174
87.7
19.4
8,446.66
Davidson
2,047
221.0
10.0
7,432.10
Oavie
700
315.3
7.8
6,456.88
IXiplin
826
246.2
1Z4
8,754.24
Durham
2,260
200.8
12.4
10359.09
Edgecombe
1,197
28Z8
14.9
10392.47
Forsyth
Franiklin
4,284
224.4
10.4
8,588.11
668
232.2
8.9
9314.38
daston
2,908
229.2
11.2
9,128.94
Gates
86
101.7
8.7
6342.53
Graham
124
182.4 -
7.0
6,494.28
Granville
580
20Z1
9.0
8355.19
Greene
255
218.3
8.9
8367.77
Guilford
5,786
237.2
9.3
8,954.33
Halifax
1,300
271.9
12.0
8,470.22
Harnett
1,265
270.9
10.2
8,14219
Haywood
1,268
255.6
24.7
7,145.70
Henderson
1,924
222.1
9.5
6,995.27
Hertford
451
233.4
8.9
6,921.45
Hoke
195
146.4
10.7
9,814.26
Hyde
160
325.2
6.8
6319.60
IredeU
2,066
283.8
8.7
9,47177
Jackson
550
267.9
6.5
5,729.13
11
APPENDIX A.2 (con't)
INPATIENT HOSPITAL UTILIZATION DATA BY COUNTY
NORTH CAROUNA RESIDENTS AGES 65 TO 74
OCTOBER 1989 — SEPTEMBER 1990
Number of
Discharge
Average
Average
Counties
Discharges
Rate
Days Stay
Charges
Johnston
1,746
275.0
10.1
$ 9,090.47
Jones
261
304.2
29.2
8,749.06
Lee
825
245.2
8.2
9,697.19
Lenoir
1,529
315.9
10.2
9,145.36
Lincoln
741
206.8
8.8
9,980.01
McDowell
781
261.6
8.0
7,401.93
Macon
790
264.6
6.5
5,827.24
Madison
264
173.2
??2
9,655.31
Martin
403
18Z5
10.9
8369.91
Mecklenburg
5,567
189.0
10.8
10,836.98
MitcheU
353
25Z3
7.5
5,797.62
Montgomery
500
25Z3
9.1
8,003.21
Moore
1,553
206.8
8.5
8,131.21
Nash
1,437
249.0
9.2
10,825.79
New Hanover
2,281
247.7
10.4
8,901.54
Northampton
552
261.5
10.4
8,197.60
Onslow
1,061
238.8
11.3
7,595.60
Orange
825
171.7
8.8
9,648.54
Pamlico
230
204.8
8.2
8352.84
Pasquotank
427
166.7
10.3
8,101.29
Pender
528
201.8
7.8
7,827.15
Perquimans
185
160.5
8.1
6396.90
Person
485
191.2
8.7
8329.57
Pitt
1,524
236.3
10.5
9,901.29
Polk
360
182.7
7.1
5,673.10
Randolph
1,642
210.6
9.4
8,154.18
Richmond
1,120
285.5
8.2
8,472.48
Robeson
1,743
248.2
9.5
9,658.81
Rockingham
1,966
27Z5
10.8
8341.35
Rowan
1,858
187.0
9.5
7,701.19
Rutherford
939
184.7
8.1
733Z36
Sampson
Scotland
963
236.4
10.0
8,757.91
565
244.8
8.5
8,739.24
Stanly
1,052
230.8
8.6
7,284.60
Stokes
539
221.7
10.1
7366.64
Surry
1,634
309.8
8.1
7,215.23
Swain
320
327.9
8.7
5347.57
Transylvania
Tyrrell
588
207.0
7.8
7384.10
81
208.8
7.5
6,759.08
Union
971
192.7
8.9
9,957.75
Vance
664
216.3
11.6
8,016.83
Wake
5,105
250.6
21.1
9337.48
Warren
302
170.3
9.7
9,163.98
Washington
289
254.6
7.6
7,626.17
Watauga
547
240.0
8.7
7,128.39
Wayne
1,726
257.5
14.1
8,138.15
Wilkes
1,249
271.9
9.4
8,031.13
Wilson
1,329
260.1
12.1
9,299.36
Yadkin
730
281.6
7.8
6,883.92
Yancey
325
217.4
8.7
8,926.14
12
APPENDIX A.3
INPATIENT HOSPITAL UTILIZATION DATA BY COUNTY
NORTH CAROLINA RESIDENTS AGES 75 TO 84
OCTOBER 1989 — SEPTEMBER 1990
Number of
Discharge
Average
Average
Counties
Discharges
Rate
Davs Stay
Charges
State
85,150
338.6
111
$8,587.94
Alamance
U98
254.5
10.6
9,263.53
Alexander
372
393.7
9.3
9,754.43
Alleghany
258
444.1
6.6
4,271.74
Anson
328
276.3
8.9
8,683.92
Ashe
483
376.5
7.4
5,181.10
Avery
406
597.9
6.4
5,01181
Beaufort
723
354.9
9.8
6,928.76
Bertie
348
351.2
10.0
7,117.29
Bladen
4?3
333.1
9.5
7,958.23
Brunswick
724
388.8
9.2
7,179.08
Buncombe
2,767
303.9
10.9
9,269.22
Burke
1,209
387.1
14.1
8,420.75
Cabarrus
1,814
418.5
14.0
8,779.84
Caldwell
1,024
381.2
9.2
9,??n.39
Camden
40
156.3
10.2
7,950.95
Carteret
736
349.8
9.8
8,075.39
Caswell
129
143.5
10.0
10,430.32
Catawba
1,209
274.6
115
10,761.10
Chatham
546
32Z.9
10.7
8,294.18
Cherokee
457
381.8
6.6
6,197.92
Chowan
220
298.1
19.1
7,163.87
Clay
114
253.9
6.0
5,835.24
Qeveland
1,??3
329.0
12.8
8,437.78
Columbus
884
420.2
11.4
9,05173
Craven
1,022
408.5
13.4
8,253.92
Cumberland
1,377
296.4
116
11,413.83
Currituck
92
175.6
9.6
8,400.33
Dare
132
165.8
115
9,211.94
Davidson
1,596
335.6
11.5
7,521.53
Davie
564
499.6
9.7
6,917.84
Duplin
723
391.0
10.3
8,408.10
Durham
1,785
275.0
15.8
10,958.97
Edgecombe
854
391.7
10.9
10,293.91
Forsyth
Franklin
3,393
329.6
117
8,558.74
571
357.3
9.9
8,755.58
Gaston
2,084
306.1
117
8,401.22
Gates
75
162.0
9.2
7376.75
Graham
124
349.3 ^-
7.3
5,559.63
Granville
434
278.0
10.8
9,272.13
Greene
199
331.7
116
8,737.79
Guilford
4,219
324.5
11.5
8,853.52
Halifax
1,050
411.0
33.3
9,728.49
Harnett
980
385.8
10.7
8,306.45
Haywood
1,088
413.5
8.1
5,527.87
Henderson
1,697
350.7
10.8
6318.37
Hertford
382
348.2
11.3
7,672.68
Hoke
157
248.4
116
9,945.64
Hyde
102
316.8
6.4
5,440.42
IredeU
1,622
407.1
10.5
9,048.69
Jackson
490
414.6
7.4
6,01135
13
APPENDIX A.3 (con't)
INPATIENT HOSPITAL DilLIZATION DATA BY COUNTY
NORTH CAROLINA RESIDENTS AGES 75 TO 84
OCTOBER 1989 — SEKl LMBER 1990
Number of
Discharge
Average
Average
Counties
Discharges
Rate
Days Stay
Charges
Johnston
1,179
367.2
10.6
$ 9,100.04
Jones
179
424.2
10.0
7,767.17
Lee
588
383.6
9.1
10,267.34
Lenoir
1,154
468.7
15.3
9,870.72
Lincoln
583
332.2
28.2
8,553.43
McDowell
648
39Z5
8.1
7,006.21
Macon
678
385.4
6.9
5,481.59
Madison
224
23Z8
9.7
8,538.18
Martin
348
301.3
12.9
9,197.73
Mecklenburg
4,058
276.1
11.8
10,238.77
MitcheU
350
411.8
7.5
5,570.05
Montgomery
374
368.5
8.8
6,626.25
Moore
1,117
317.4
12.5
7,911.32
Nash
1,121
389.8
1Z7
11,674.86
New Hanover
1,482
334.7
12.3
9303.26
Northampton
298
290.7
37.4
7,844.84
Onslow
672
359.4
12.1
7,772.73
Orange
660
259.1
10.5
10,180.11
Pamlico
190
346.7
11.5
9,775.98
Pasquotank
442
324.0
14.8
8,858.55
Pender
417
363.2
8.7
7388.33
Perquimans
154
247.6
8.7
7,911.85
Person
450
321.7
10.6
9,901.59
Pitt
1,095
335.8
15.0
936134
Polk
331
278.4
6.9
5397.83
Randolph
1,176
286.3
9.8
8,499.71
Richmond
832
432.0
9.4
8,299.17
Robeson
1,201
343.1
112
11,209.79
Rockingham
1347
393.2
10.6
7,806.83
Rowan
1,464
266.5
10.1
6,280.88
Rutherford
886
299.4
10.3
7,890.06
Sampson
Scotland
766
344.7
10.7
8305.04
471
394.8
9.7
9329.58
Stanly
904
360.4
10.2
7,017.06
Stokes
477
350.2
10.7
7,200.55
Surry
1,255
416.9
8.4
6,623.84
Swain
267
446.5
8.3
5341.69
Transylvania
Tyrrell
432
299.2
9.3
8,131.38
56
239.3
8.6
9,084.99
Union
733
292.1
14.4
9390.86
Vance
499
307.5
8.4
6,479.04
Wake
3,748
371.0
18.8
9,051.17
Warren
222
232.5
17.9
9395.53
Washington
219
353.2
7.9
738178
Watauga
431
362.2
8.1
6,047.96
Wayne
1,141
357.9
14.1
8,981.87
Wilkes
1,036
408.5
9.8
7332.79
Wilson
862
334.8
12.6
9,977.64
Yadkin
596
400.3
8.0
6,438.43
Yancey
330
379.7
8.4
6,921.00
14
APPENDIX A.4
[NPATIENT HOSPITAL UTILIZATION DATA BY COUNTY
NORTH CAROL
OCIC
INA RESIDENTS AGES
85 AND OLDER
R1990
BER 1989 — SEP I EMBE
Number of
Discharge
Average
Average
Counties
Discharges
Rate
Days Stay
Charges
State
31,935
446.9
12.1
$ 7,853.74
Alamance
463
338.7
11.1
7,911.64
Alexander
169
6416
10.8
7,537.76
Alleghany
148
800.0
6.6
3347.45
Anson
146
372.4
12.3
9,043.79
Ashe
255
595.8
8.5
5,208.26
Avery
165
S54.9
6.4
4,943.77
Beaufort
253
449.4
8.4
5,550.92
Bertie
135
584.4
17.1
7,206.26
Bladen
144
435.0
9.5
7391.66
Brunswick
321
736.2
8.6
6,081.44
Buncombe
1,078
356.6
11.0
8,26128
Burke
429
566.7
20.9
7369.49
Cabarrus
626
581.2
13.7
7,443.46
Caldwell
389
561.3
9.9
7,745.74
Camden
25
416.7
11.0
8,649.85
Carteret
277
471.9
10.4
6,664.52
Caswell
30
113.6
25.5
11,647.09
Catawba
417
367.1
IZO
9,27150
Chatham
184
351.1
11.4
7,43198
Cherokee
216
574.5
7.2
5,835.00
Chowan
98
387.4
9.6
7,624.41
Clay
54
465.5
5.3
4,633.15
Qeveland
494
494.0
13.0
7,773.36
Columbus
287
544.6
13.5
9,288.51
Craven
360
542.2
1Z9
7,793.66
Cumberland
484
445.7
14.0
11,404.20
Currituck
35
289.3
10.7
7383.91
E>are
51
260.2
15.6
936105
Davidson
516
430.0
13.9
7,801.48
Davie
213
647.4
9.1
5,424.48
EXiplin
158
348.0
13.1
8,711.27
Durham
664
323.9
16.1
9,926.11
Edgecombe
312
513.2
16.3
12,717.65
Forsyth
1,479
423.2
1Z6
7,470.73
Franklin
278
528.5
11.3
9,003.67
Gaston
690
399.8
14,?
8,156.49
Gates
22
207.5
9.2
7,021.35
Graham
43
417.5
9.7
6,93181
Granville
167
36Z3
10.5
7,737.43
Greene
60
422.5
21.1
10,003.12
Guilfond
1,645
389.3
11.5
7,94106
Halifax
353
473.2
15.2
9309.05
Harnett
304
475.7
9.8
738183
Haywood
556
649.5
8.9
5396.59
Henderson
799
545.8
10.4
6,011.30
Hertford
179
534.3
10.5
6367.72
Hoke
86
46Z4
15.6
10,024.72
Hyde
41
500.0
6.3
4,761.28
Iredell
572
526.2
11.1
8,621.07
Jackson
198
528.0
7.2
5,172.15
15
APPENDIX A.4 (con't)
INPATIENT HOSPITAL U'llLIZATION DATA BY COUNTY
NORTH CAROLINA RESIDENTS AGES 85 AND OLDER
OCTOBER 1989 — SEPTEMBER 1990
Number of
Discharge
Average
Average
Counties
Discharges
Rate
Davs Stay
Charges
Johnston
373
478.2
1Z9
$ 8,475.77
Jones
57
633.3
9.4
7,028.31
Lee
148
324.6
8.7
7,897.22
Lenoir
359
604.4
17.5
10,314.92
Lincoln
173
373.7
11.6
8,970.58
McDowell
??3
47Z5
8.5
6,865.22
Macon
306
655.2
7.2
5,213.60
Madison
99
348.6
8.5
6,73120
Martin
107
376.8
8.8
6,545.03
Mecklenburg
1,546
342.3
11.9
8356.67
Mitchell
203
751. ^
8.4
5,706.4^
Montgomery
146
553.0
9.8
6,631.78
Moore
393
437.2
13.4
8,013.95
Nash
353
441.3
15.1
11,86195
New Hanover
509
408.8
11.5
7,785.41
Northampton
124
405.2
11.6
7,057.56
Onslow
285
579.3
10.2
6,808.41
Orange
240
288.5
10.0
8,533.50
Pamlico
82
416.2
10.6
7,90183
Pasquotank
184
424.9
14.5
9,929.19
Pender
175
550.3
13.1
8,21172
Perquimans
48
289.2
8.3
5,836.50
Person
136
362.7
8.6
6,190.25
Pitt
367
415.6
14.9
9,491.40
Polk
171
426.4
7.9
5,150.04
Randolph
324
33Z0
9.7
7,507.84
Richmond
293
566.7
10.8
8,09134
Robeson
401
447.0
13.2
9,771.73
Rockingham
542
519.2
13.0
7,717.59
Rowan
628
384.6
11.6
6,506.90
Rutherford
381
447.2
11.0
7358.37
Sampson
Scotland
288
514.3
11.2
7,95110
106
424.0
11.3
8367.70
StarJy
281
477.9
10.1
5,847.90
Stokes
202
505.0
10.8
7,01148
Surry
479
546.8
8.6
5,856.51
Swain
131
708.1
8.3
5,160.99
Transylvania
Tyrrell
IJnion
133
353.7
7.1
5,224.62
24
421.1
6.3
4350.47
258
372.3
11.8
9,029.73
Vance
161
335.4
14.5
7330.50
Wake
1,582
513.3
17.0
9304.97
Warren
68
23Z1
115
6,825.43
Washington
97
673.6
7.6
5369.30
Watauga
229
530.1
9.0
6393.80
Wayne
349
412.5
20.4
7,916.09
Wilkes
324
506.3
9.6
7323.98
Wilson
316
4713
15.1
9,684.24
Yadkin
227
543.1
8.7
6,117.75
Yancey
165
665.3
9.0
6,198.67
16
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APPENDIX C
INTERNATIONAL CLASSIHCATION OF DISEASES CODES
(NINTH REVISION) FOR PRINQPAL DIAGNOSES
AND COMORBID CONDITIONS
CONDITION ICD CODES
Infectious and parasitic conditions 001-139
Cancer 140-208
Trachea, bronchus, and lung 162
Skin 172
Female breast 174
Cervix uteri 180
Ovary & other uterine adnexa 183
Prostate 185
Bladder 188
Brain 191
Thyroid 193
Hodgkin's disease 201
Leukemia 204-208
Thyroid gland disorders 240-246
Diabetes 250
Nutritional disorders 260-269
Mental disoniers 290-319
Psychoses 290-299
Alcohol dependence syndrome 303
Drug dependence 304
Alzheimer's 331.0
Parkii^on's 332
Glaucoma 365
Cataract 366
Heart disease 390-398,402,404-429
Hypertension 401,403
Cerebrovascular disease 430-438
Pneumonia and influenza 480-487
Chronic obstructive pulmonary disease 490-496
Pancreatitis 577
Nephritis, nephrotic syndrome, and nephrosis 580-589
Rheumatoid arthritis 714.0
Poisoning 960-979
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STATE LIBRARY OF NORTH CAROLINA
3 3091 00004 6243
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Department of Environment, Health, and Natural Resources
State Center for Health and Environmental Statistics
P.O. Box 29538
Raleigh, N.C. 27626-0538
919/733-4728
BULK RATE
U.S. Postage
PAID
Raleigh. N.C. 27626-0538
Pemnit No. 1862
850 copies of this public document were printed at a cost of $195.50 ot 230 per copy.
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